Z Take this folder with you to your

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1 my health care notebook Why? Being an active part of your health care team helps you feel better and helps you get even better care. Starting on Day 1, you can keep track of important information and questions. My health care notebook helps you stay informed about your care and prepares you for going home. Who? This is your notebook, so start using it right away. If you don t feel well, your family care partner can start using it. Ask your nurse if you need help with information you do not know. When? Use my health care notebook from the start to help staff get to know you and to record important information. How? Z Fill out my health care notebook where you can. Z Talk to your health care team. Z Write down any questions you have. Z Use the back pocket of this folder for important information sheets, such as your Discharge instructions now called your After Visit Summary (AVS). Z Take this folder with you to your appointments after you leave the hospital. d What s Inside? My health care team... 3 My plan of care My medicines My allergies, diet, activities & exercises Preparing to leave Care coordination for when I leave My discharge checklist

2 page 2 my health care notebook Z Your Observation Outpatient Dates From To Z Your Hospital Inpatient Dates From To Z Z Z To help staff get to know you better, please write down something interesting about you. Nurse Bedside Shift Report We encourage you and your family care partner to join with your nurses in Bedside Shift Report. At this time, your nurse going off duty shares important information about you with your nurse coming on duty at your bedside. Bedside Shift Report helps make sure you get high-quality care. If you have questions or concerns, Bedside Shift Report provides a good time to raise them. Ask your nurse if you have questions about the report. Z Patients and Families: You are Part of the Health Care Team! hopkinsmedicine.org/suburban_hospital

3 my health care notebook page 3 my health care team You and Your Family Care Partner You are a key member of your health care team. You also choose your care partner to help support you during your hospital stay. You may choose a relative or friend. You may have more than one care partner, but name one to be the lead. Z Your Care Partner s Name Z Phone Contact (home) (work) You and your family know you best. If you see a sudden decline in condition, immediately first tell your nurse or physician or call the Rapid Response Team at x14. (cell) Z Your Primary Hospital Physicians Z Other Physicians

4 h k page 4 my health care notebook my health care team continued Z Nurses Z Care coordinator (social worker or care manager) Z Specialists (respiratory therapist, physical therapist, occupational therapist, speech therapist, wound therapist) Z Hospital pharmacists Z Patients and Families: You are Part of the Health Care Team! hopkinsmedicine.org/suburban_hospital

5 my health care notebook page 5 my daily plan of care Your daily Plan of Care includes your goal, tests and activities. See your white Communication Board for your Plan of Care. It may change each day. List your questions and any notes about your condition and treatment. Date Questions & Notes

6 page 6 my health care notebook my daily plan of care continued Your daily Plan of Care includes your goal, tests and activities. See your white Communication Board for your Plan of Care. It may change each day. List your questions and any notes about your condition and treatment. Date Questions & Notes Z Patients and Families: You are Part of the Health Care Team! hopkinsmedicine.org/suburban_hospital

7 my health care notebook page 7 my medicine while i am in the hospital Z When you are in the hospital Ask your nurse about any medicine you don t recognize. If you want, your nurse can give you a list of the medicines you are taking in the hospital. The list may include medicines you will not take when you go home. When you go home The medicine you take may change. Look at your After Visit Summary (AVS) to know what medicine you must stop and what you must take. Only take medicine listed on your After Visit Summary (AVS) until you talk to your primary care physician. Before you leave, review your medicine with your nurse and ask questions. Z My medicine questions for my nurse, physician or hospital pharmacist

8 page 8 my health care notebook notes for my health Z My Food and Medicine Allergies Z Z My Diet While I Am in Suburban Z My Activities and Exercises Z Patients and Families: You are Part of the Health Care Team! hopkinsmedicine.org/suburban_hospital

9 my health care notebook page 9 preparing to leave the hospital Z Appointments I Have Scheduled or Need to Schedule Scheduled Name and Phone # Date and Time Reason for Visit Yes No Yes No Yes No Yes No Z Pending Tests or Results Z Tests I Need After I Leave the Hospital Z My Pharmacy Information Ask your nurse to update your medical chart about your pharmacy or pharmacies if you use more than one. Name Name Phone Phone

10 k page 10 my health care notebook care coordination for when i leave Speak with your care coordinator if you need help to answer the following questions. Z When I go home, will I have what I need? Yes No Medicines Transportation to appointments Fresh food Other Z When I go home, will I have Home Health Services? Yes No If yes, list type of service, name of company and phone number. Z When I go home, will I have Medical Equipment? Yes No If yes, list kind of equipment, name of company and phone number. Z Patients and Families: You are Part of the Health Care Team! hopkinsmedicine.org/suburban_hospital

11 my health care notebook page 11 my discharge preparation checklist Please check each box before leaving Suburban and note your questions. I have been involved in decisions about what will take place after I leave (treatment, therapies, future appointments). If you are not going home I understand where I am going after I leave and what will happen to me once I arrive. I understand which symptoms to watch for and know whom to call if I notice them. I understand what medicine I need to take when I go home today and until I see my physician, how to get them and how to take them. I understand the possible side effects of my medicine, and who to call if I experience them. Z

12 page 12 my health care notebook my discharge preparation checklist continued My family or someone close to me knows that I am leaving Suburban, and what I will need when I get home. v I have scheduled a follow-up appointment with my physician and have transportation to get to the appointment. My physician or nurse has answered my questions in a way I understand. I have the name and phone number of the person to contact if I have a health problem after my discharge. I understand what I need to do to take care of myself after I leave. We adapted this checklist from a tool developed by Eric Coleman, MD, MPH, with funding from the John A. Hartford Foundation and the Robert Wood Johnson Foundation.